Provider Demographics
NPI:1659845915
Name:GOETTL, BRITTAINI LANIKA
Entity Type:Individual
Prefix:
First Name:BRITTAINI
Middle Name:LANIKA
Last Name:GOETTL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 BROADWAY ST SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-2077
Mailing Address - Country:US
Mailing Address - Phone:541-974-4517
Mailing Address - Fax:
Practice Address - Street 1:840 BROADWAY ST SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2077
Practice Address - Country:US
Practice Address - Phone:541-908-5701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201506078RN163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty